NPIMap

Organization Active NPI

Dental Professionals of Indiana, P.C.

  • General Practice Dentistry
  • Elkhart, IN
National Provider Identifier
1861027609
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF INDIANA, P.C.
Doing business as
Complete Family Dentistry
Practice address
415 Waterfall Dr Ste a
Elkhart, IN 46516-3660
Phone
(574) 293-8744
NPI assigned
Mar 11, 2020
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF INDIANA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tabatha Lemke
Title
Cred Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

415 Waterfall Dr Ste a
Elkhart, IN 46516-3660

Mailing address

415 Waterfall Dr Ste a
Elkhart, IN 46516-3660

Other names 1

  • Complete Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Heartland Dental Care of Indiana PC48 organizations share this tax ID, including this one
Part of
Heartland Dental Care of Indiana PC

Other organizations with this tax ID 47

Organizations that report the same tax identification number in the National Provider Directory.

View all 47

Locations

415 Waterfall Dr
#A
Elkhart, IN 46516
Phone (574) 293-8744

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1861027609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 WATERFALL DR STE A",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465163660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 WATERFALL DR STE A",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465163660",
            "telephone_number": "574-293-8744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF INDIANA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF INDIANA, P.C.",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CRED COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.